Counselling Contract

Counselling Contract

In a EMERGENCY please contact your own GP. The Cumbria Health On Call team (CHOC) are also available out of hours on 111. The Samaritans are available 24 hours a day on 116 123.

SAFA is GDPR compliant. Once the below form is submitted to us, the forms data is encrypted and automatically password protected. Only a team member from SAFA can access the data provided.

Confidentiality Agreement

Statement by SAFA

SAFA aims to create a safe and secure environment. Within SAFA, we will maintain confidentiality for clients who use our service. We are committed to providing this confidential space which you can speak openly and freely with your counsellor during your appointment.

Our sessions are confidential; this means SAFA will not disclose information unless you give us permission to do so.

However in certain exceptional circumstances, it may be necessary for us to break confidentiality.
This includes areas relating to child protection issues; situations where you disclose you are feeling suicidal; where there is a risk to others, or where there is a legal requirement and whilst we are willing to share these records/notes with you in person on SAFA premises if we believe it is in your best interests, We are unable to share records/notes with any third party without a court order.

Wherever possible, you may be involved in this process and encouraged to make the relevant information available to the appropriate body, and SAFA will ensure you are given appropriate support during this time.

During the Covid 19 pandemic, SAFA will be offering telephone appointments and online appointments via Zoom. We will make every effort to ensure that confidentiality is maintained: our counsellors will ensure that online counselling sessions are conducted with the highest level of security.

Agreement by client

Please make every effort to ensure your privacy and have a space where you cannot be overheard. This also includes emails or text messages from SAFA, please use strong passwords on your computer and email accounts.

I agree that SAFA will keep notes of our sessions, which are kept digitally on a secure system, these records/notes are simply used as a record of our time together and are not intended to be used for evidential purposes (see above). I understand that I cannot be directly identified from these notes.

It is mutually agreed by yourself and your counsellor that neither will voice or video record the session.

Occasionally SAFA’s counsellors collect case studies, these are used to enhance the service we provide and to demonstrate real life experiences to funders and commissioners the work that is carried out. All case studies are anonymous and NO client identity is revealed throughout this process. A case study comprises a brief overview of why a client came to therapy, the therapy provided by the counsellor and how the therapy is progressing. If you are happy for this to occur please opt in at the end of this contract.

SAFA have organisational membership of The British Association for Counselling and Psychotherapy (BACP) and outlined in their ethical framework it is a professional requirement that all counsellors must have regular ongoing supervision. This is to ensure that I receive the best possible service. To ensure confidentiality, I would not be directly identified.

Appointment cancellations

I agree to meet for weekly sessions, each session lasting approximately lasting 50 minutes. If I am unable to attend for whatever reason, I will let SAFA know and give 24 hours notice.

How to cancel

  • By phone: 01229 832269 (if no-one is available to take the call directly, I shall leave a message as this is a confidential line)
  • By text: 07508035048
  • By email: info@safa-selfharm.com
  • Or by contacting the counsellor directly.

Late or non-attendance of appointment

Telephone appointments

I understand that if I choose not to answer my telephone, my counsellor will wait 10 minutes and make one more attempt at contacting me before logging a missed appointment.

Zoom appointments

I understand that if I do not attend my Zoom appointment or make contact with my counsellor to let them know I am experiencing technical difficulties, my counsellor will wait 10 minutes before logging a missed appointment.

I understand that if during my appointment connection to the platform we are using is lost, my counsellor will attempt to re-establish a connection, should this be unsuccessful, a message will be sent to me to arrange an alternative appointment (either by phone, text message or email, as agreed at the beginning of the counselling relationship).

If contact between sessions is deemed essential i.e. change of appointments etc., I note that any communication (by phone, text or email) will be acknowledged but my counsellor will not enter into any dialogue. If I miss or cancel a session without giving 24 hours notice, the missed session will count as a session. I understand that if I Do Not Attend (DNA) twice SAFA will presume that I no longer want to attend and will take me off their list. I will still be able to re-refer and will go back onto SAFA’s waiting list.

If for any reason my counsellor needs to cancel the session, she/he will do their utmost to contact me as soon as possible.

If I arrive under the influence of drugs or alcohol, my counsellor reserves the right to cancel this session.

* I understand the above Counselling Contract and agree to receive counselling from SAFA under the terms above.

    By ticking this box I hereby confirm my acceptance for my counsellor to complete an anonymous case study. Please complete the following:

    Digital Signature - Please input using a keypad or keyboard.

    Please prove you are human by selecting the Cup.

    Complaints procedure

    We are committed to providing a high-quality service to all our clients. When something goes wrong, we need you to tell us about it. This will help us to improve our standards. If you have a complaint, please contact Cindy Daltioni on 01229 832269 or cindy@safa-selfharm.com to discuss your queries or concerns.

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